摘要
目的探讨经腹膜外入路单一部位腹腔镜腹膜后淋巴结清扫术的可行性。方法 2010年9月,对1例睾丸非精原细胞瘤行右侧睾丸根治性切除术,术后20 d行经腹膜外入路单一部位腹腔镜腹膜后淋巴结清扫术。采用右侧下腹部腹直肌外侧缘纵行切口,置入"两环一套法"自制开口器建立单孔腹腔镜通道。手术步骤及清扫范围同开放保留神经的腹膜后淋巴结清扫手术范围。结果手术顺利,手术时间270 min,术中出血量为100 ml,无须输血。无围手术期死亡及严重并发症发生。术后病理:2/11淋巴结为阳性。术后2 d肠蠕动恢复,4 d拔除腹膜后引流管,10 d出院。术后6个月随访,AFP降至正常(2.82μg/L),未发现肿瘤复发和远处转移,患者对切口美容效果表示满意。结论经腹膜外入路单一部位腹腔镜腹膜后淋巴结清扫术可行,美容效果较好,短期随访显示肿瘤控制及性功能恢复好。
Objective To verify the feasibility of laparoscopic single-port retroperitoneal lymph node dissection（RPLND） for nonseminomatous testicular cancer（NSGCT）.Methods In September 2010,a 19-year-old male patient with NSGCT underwent right radical orchidectomy in our hospital.The histopathological analysis revealed mixed nonseminomatous germ cell tumor with embryonal carcinoma and teratoma.He underwent laparoscopic single-port RPLND 20 days later.During the operation,the patient was placed in a supine position with the affected side elevated 20 degree.After a 3-cm right lateral rectus incision was made in the right lower quadrant,a port made of 2 rings and one surgical glove were inserted.Retroperitoneal space was then made and developed with blunt dissection.Unilateral RPLND with nerve-sparing technique was conducted and a modified right-sided template was removed in accordance with open RPLND.Results The operation was successfully performed through a solo pararectus incision within 270 minutes with an estimated blood loss of 100 ml.No conversion to open or conventional laparoscopic surgery was required.No major perioperative complications was observed.2/11 positive lymph nodes were detected on final histopathological examination.Chemotherapy was needed for further treatment.The patient had his gastrointestinal function recovered in 2 days,and the retroperitoneal drainage tube being withdrawn in 4 days.He was discharged from hospital in 10 days.His AFP level decreased to 2.82 μg/L 6 months postoperation and no relapse or metastasis was observed during a 6-month follow-up.Conclusions Laparoscopic single-port RPLND is feasible for nonseminomatous testicular carcinoma with good cosmetic results.Short-term follow-up showed good results on tumor control and recovery of sexual function.
出处
《中国微创外科杂志》
CSCD
2011年第10期917-920,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
单一部位
腹腔镜
腹膜后淋巴结清扫术
非精原细胞瘤
睾丸肿瘤
Single-site
Laparoscope
Retroperitoneal lymph node dissection（RPLND）
Nonseminomatous germ cell tumors（NSGCT）
Testicular cancer
